Two articles, both in Healthcare IT News, caught my attention today. The first was an article by Erin McCann that reports on the results of a new survey. It suggests that the use of electronic health records (EHRs) by family physicians in America could exceed 80 percent by 2013. The survey from member researchers at the Association of American Medical Colleges says family doctors are adopting electronic health records at a much faster rate than previous data has suggested. Nationwide, nearly 70 percent of family docs are using electronic records. The other article I noted in the same news publication reports that both the American Medical Association and the College of Healthcare Information Management Executives have submitted comments to the Office of the National Coordinator for Health Information Technology (ONCHIT) airing their concerns about Stage 3 meaningful use criteria. Among other issues, the organizations don’t like the fact that meaningful use reporting takes a “one-size-fits-all” approach and fails to recognize the different practice patterns of various specialties.
So how do these two reports fit together? Well first of all, we can crow all we want about the rapid uptake of electronic health records by family doctors in America, but the fact is that our docs are still far behind most of their colleagues in Europe and Asia when it comes to using EHRs. In many Western European nations, especially the Nordic countries, the use of EHRs by primary care doctors is nearly 100 percent and has been that way for a decade or more. The new American survey also points out that EHR use by family docs is highly uneven on a state by state comparison. For example, nearly 95 percent of docs in Utah are using electronic records, but only 41 percent of family physicians in North Dakota have adopted EHRs. The is also wide variation by specialty. Compared to family physicians, overall use by pediatricians is a dismal 41 percent. As might be expected, EHR usage tends to be much higher in large group practices and integrated delivery networks than in free-standing small group practices, partnerships or solo doctor offices.
The root cause of the variation of EHR use by specialty is likely two-fold. First of all, for many high-earning medical specialists the incentives put forth by the federal government to encourage adoption of EHRs are seen by many doctors as not worth the bother. When they consider possible reductions in initial productivity while learning to use an EHR and the hassle-factor of meaningful use reporting, many high income docs are simply turning up their noses. However, anecdotally I would say there is another, even more important reason for this and it takes me back to that “one-size-fits-all” comment. “One-size-fits-all” is also a problem for many specialists who might like to use electronic medical records, but find few choices on the market that are a really good fit with their specialty or practice.
I live and work in one of the country’s high tech capitols. Yet, my family’s dermatologist, podiatrist, ob-gyn, general surgeon, orthopedic specialist, ophthalmologist, sports medicine doctor and many others I could cite still use paper charts and show very little interest in changing their ways. I don’t think this is because they are too old, or not interested in technology. And, most of these docs are high-income earners. They certainly could afford anything they might want regardless of federal meaningful use incentives. They don’t buy because they can’t find what they need.
I can’t tell you how many conversations I’ve had with my dermatologist and ophthalmologist about electronic records and why most solutions on the market don’t work for them. Their specialties have very different documentation needs compared to colleagues who practice general internal medicine or family medicine. Often, they tell me that all they really need is a few, very specific and specialized electronic forms or templates in which they could enter the discrete data they gather during an exam. They have no need for screen after screen about other organ systems, procedures, diagnoses, etc.
As I think about some of our Microsoft partners and industry solution vendors around the world, large and small, I think there are some real opportunities to develop new apps using Windows 8 and its modern (touch, voice, keyboard, and stylus-friendly) UI, to design the kinds of solutions that will meet the needs of specialty clinicians. They could take advantage of a new generation of highly mobile and very secure devices, from smartphones to slate tablets, ultrabooks, and notebook PCs, to create elegant electronic solutions, distributed via our Windows Store, that have exactly what these doctors need, and perhaps even more importantly, do not force them to buy or use what they don’t need. I believe only then will we see widespread adoption of electronic records by all clinicians in every specialty around the world. Of course, it goes without saying that such solutions must also be able to exchange information with all other systems. Until that happens, healthcare will remain a fragmented, hodgepodge environment for data and information that pleases neither clinicians nor their patients.
Bill Crounse, MD Senior Director, Worldwide Health Microsoft